Tilt training and pacing: a report on 9 patients with neurally mediated syncope

Abstract

Objective — In patients with neurally mediated syncope (NMS), pacing has been used to prevent bradycardia and syncope. However, recurrence due to the vasodepressor component remains a problem.

Methods — We report on tilt training in 9 patients with a pacemaker (PM) implantation. Patients were submitted to daily in-hospital tilt testing. They were instructed to continue this therapy at home.

Results — A negative tilt test was obtained in all patients. Six patients remained free from syncope. Recurrent syncope was observed in 3 patients. In 4 patients the pacemaker had been implanted before the start of the tilt training programme. Five patients had a pacemaker implanted after the administration of tilt training therapy.

Conclusion — NMS also occurs in paced patients. Tilt training improves the clinical outcome by restoring the vasoconstrictor reserve capacity.

Key Words:

• Neurally mediated syncope
• tilt training
• tilt table testing
• pacemaker